Provider Demographics
NPI:1982206553
Name:KINTSUGI THERAPEUTIC SERVICES
Entity Type:Organization
Organization Name:KINTSUGI THERAPEUTIC SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MONIKA
Authorized Official - Middle Name:L
Authorized Official - Last Name:SCOTT-ROGERS
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LPC
Authorized Official - Phone:864-747-0678
Mailing Address - Street 1:151 MITCHELL RD APT L4
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29615-2660
Mailing Address - Country:US
Mailing Address - Phone:864-747-0678
Mailing Address - Fax:
Practice Address - Street 1:151 MITCHELL RD APT L4
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29615-2660
Practice Address - Country:US
Practice Address - Phone:864-747-0678
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-09
Last Update Date:2020-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)